{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T18:59:07Z","timestamp":1770663547741,"version":"3.49.0"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: This study aimed to evaluate the outcomes and complications of laparoscopic varicocelectomy (LV) in pediatric and adolescent patients, comparing lymphatic-sparing (LS) and non-lymphatic-sparing (NLS) techniques, with a particular focus on the postoperative effects of methylene blue dye. Methods: A retrospective review was conducted for patients with Grade 3 left-sided varicocele who underwent LV between 2010 and 2023. Patients were grouped according to whether lymphatic-sparing techniques were used. Testicular volumes were measured pre- and postoperatively by ultrasonography. Surgical complications including hydrocele, recurrence, and intratesticular calcification were recorded. Statistical comparisons were made between the two groups. Results: A total of 21 patients with a median age of 15 years were included. LS suvrgery was performed in seven patients (33.3%), and arterial sparing in four (19%). Methylene blue was used to identify lymphatic vessels in the LS group. Postoperative hydrocele was observed in three patients (14.3%) and occurred equally in both groups. However, testicular calcification was detected only in the LS group and was significantly more common compared to the NLS group (p = 0.002). Recurrence rates were not significantly different between groups (p = 0.694). No cases of testicular atrophy were observed. The median follow-up duration was 6 years in the NLS group and 3 years in the LS group (p = 0.026). Conclusions: Lymphatic-sparing laparoscopic varicocelectomy appears effective in preserving testicular volume, but the use of intratesticular methylene blue is associated with a higher incidence of calcification. These findings highlight the need for caution and further long-term evaluation of vital dyes in pediatric varicocelectomy.<\/jats:p>","DOI":"10.3390\/jcm14113814","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T06:25:04Z","timestamp":1748499904000},"page":"3814","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Retrospective Analysis of Laparoscopic Varicocelectomy in Pediatric Patients: Impact of Lymphatic-Sparing Techniques and Methylene Blue on Outcomes\u2014A Series of Cases"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2049-4549","authenticated-orcid":false,"given":"Arzu","family":"Canmemis","sequence":"first","affiliation":[{"name":"Division of Pediatric Urology, Department of Pediatric Surgery, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, 34722 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meltem","family":"Caglar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, 34722 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cigdem","family":"Ulukaya Durakbasa","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Istanbul, Faculty of Medicine, Istanbul Medeniyet University, 34730 Istanbul, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17562872231206239","DOI":"10.1177\/17562872231206239","article-title":"Outcome following the surgical management of varicocele in children and adolescents: A systematic review and meta-analysis","volume":"15","author":"Tandon","year":"2023","journal-title":"Ther. Adv. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1046\/j.1464-410X.2000.00735.x","article-title":"The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents","volume":"86","author":"Akbay","year":"2000","journal-title":"BJU Int."},{"key":"ref_3","unstructured":"Radmayr, C., Bogaert, G., Burgu, B., Castagnetti, M.S., Dogan, H.S., O\u2019Kelly, F., Quaedackers, J., Rawashdeh, Y.F.H., Silay, M.S., and Hoen, L.A. (2023). European Association of Urology Guidelines on Paediatric Urology, European Association of Urology."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/S0022-5347(05)63988-2","article-title":"Optimizing the operative treatment of boys with varicocele: Sequential comparison of 4 techniques","volume":"169","author":"Riccabona","year":"2003","journal-title":"J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/S0022-5347(17)37035-0","article-title":"Microsurgical inguinal varicocelectomy with delivery of the testis: An artery and lymphatic sparing technique","volume":"148","author":"Goldstein","year":"1992","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1097\/01.ju.0000097400.67715.f8","article-title":"Intraoperative varicocele anatomy: A microscopic study of the inguinal versus subinguinal approach","volume":"170","author":"Hopps","year":"2003","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1097\/01.ju.0000154357.72837.43","article-title":"Lymphatic sparing laparoscopic varicocelectomy: A microsurgical repair","volume":"173","author":"Kocvara","year":"2005","journal-title":"J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"227","DOI":"10.21037\/tp.2016.09.11","article-title":"Surgical approaches for varicocele in pediatric patient","volume":"5","author":"Parrilli","year":"2016","journal-title":"Transl. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S0302-2838(03)00051-4","article-title":"Division of lymphatic vessels at varicocelectomy leads to testicular oedema and decline in testicular function according to the LH-RH analogue stimulation test","volume":"43","author":"Kocvara","year":"2003","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1055\/s-0031-1271733","article-title":"Lymphatic sparing versus lymphatic non-sparing laparoscopic varicocelectomy in children and adolescents: A systematic review and meta-analysis","volume":"21","author":"Liang","year":"2011","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.juro.2008.03.064","article-title":"Laparoscopic lymphatic sparing varicocelectomy in adolescents","volume":"180","author":"Glassberg","year":"2008","journal-title":"J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1046\/j.1464-410X.2001.00171.x","article-title":"The use of isosulphan blue to identify lymphatic vessels in high retroperitoneal ligation of adolescent varicocele\u2013avoiding postoperative hydrocele","volume":"87","author":"Oswald","year":"2001","journal-title":"BJU Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"217.e1","DOI":"10.1016\/j.jpurol.2022.11.007","article-title":"Long lasting effect on testes following methylene blue injection in laparoscopic lymphatic sparing varicocelectomy","volume":"19","author":"Hung","year":"2023","journal-title":"J. Pediatr. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jpedsurg.2013.12.022","article-title":"Technical standardization of laparoscopic lymphatic sparing varicocelectomy in children using isosulfan blue","volume":"49","author":"Esposito","year":"2014","journal-title":"J. Pediatr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"282.e1","DOI":"10.1016\/j.jpurol.2023.11.018","article-title":"Indocyanine green (ICG)-GUIDED lymphatic sparing laparoscopic varicocelectomy in children and adolescents. Is intratesticular injection of the dye safe? A mid-term follow-up study","volume":"20","author":"Esposito","year":"2024","journal-title":"J. Pediatr. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1089\/lap.2012.0060","article-title":"Blue patent lymphography prevents hydrocele after laparoscopic varicocelectomy: 10 years of experience","volume":"22","author":"Chiarenza","year":"2012","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/S0022-5347(17)37561-4","article-title":"Testicular volume assessment in the adolescent with a varicocele","volume":"147","author":"Costabile","year":"1992","journal-title":"J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/bjs\/znad034","article-title":"Implementation and validation of a novel instrument for the grading of unexpected events in paediatric surgery: Clavien-Madadi classification","volume":"110","author":"Kuebler","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/S0015-0282(16)37684-1","article-title":"Varicocele size and results of varicocelectomy in selected subfertile men with varicocele","volume":"21","author":"Dubin","year":"1970","journal-title":"Fertil. Steril."},{"key":"ref_20","unstructured":"Damsgaard, J., Joensen, U.N., Carlsen, E., Erenpreiss, J., Blomberg Jensen, M., Matulevicius, V., Zilaitiene, B., Olesen, I.A., and Perheentupa, A. (2020, November 21). The jamovi Project (2024). Jamovi. (Version 2.5) [Computer Software. Available online: https:\/\/www.jamovi.org."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"49.e1","DOI":"10.1016\/j.jpurol.2020.11.024","article-title":"Hormonal evaluation in adolescents with varicocele","volume":"17","author":"Zampieri","year":"2021","journal-title":"J. Pediatr. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1097\/JU.0000000000001405","article-title":"Total Motile Sperm Count in Adolescent Boys with Varicocele is Associated with Hormone Levels and Total Testicular Volume","volume":"205","author":"Lawton","year":"2021","journal-title":"J. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"World Health Organization (1992). The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil. Steril., 57, 1289\u20131293.","DOI":"10.1016\/S0015-0282(16)55089-4"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.jpurol.2017.07.008","article-title":"Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials","volume":"13","author":"Locke","year":"2017","journal-title":"J. Pediatr. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/j.1464-410X.2010.09959.x","article-title":"Review of current varicocelectomy techniques and their outcomes","volume":"108","author":"Diegidio","year":"2011","journal-title":"BJU Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/S0022-5347(17)69113-4","article-title":"Radical cure of varicocele by a new technique: Preliminary report","volume":"61","author":"Palomo","year":"1949","journal-title":"J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1464-410X.1994.tb16557.x","article-title":"Laparoscopic procedure for varicocelectomy","volume":"74","author":"Mischinger","year":"1994","journal-title":"Br. J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1089\/lap.2006.0072","article-title":"Dye-assisted lymph vessels sparing laparoscopic varicocelectomy","volume":"17","author":"Golebiewski","year":"2007","journal-title":"J. Laparoendosc. Adv. Surg. Tech."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jpurol.2011.11.004","article-title":"Dye-assisted lymphatic-sparing laparoscopic varicocelectomy in children","volume":"9","author":"Capolicchio","year":"2013","journal-title":"J. Pediatr. Urol."},{"key":"ref_30","first-page":"126","article-title":"Laparoscopic Palomo varicocele surgery: Lessons learned after 10 years\u2019 follow up of 156 consecutive pediatric patients","volume":"5","year":"2008","journal-title":"J. Pediatr. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/S0022-5347(05)00402-7","article-title":"Hydrocele formation following laparoscopic varicocelectomy","volume":"175","author":"Hassan","year":"2006","journal-title":"J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"152.e1","DOI":"10.1016\/j.jpurol.2017.12.008","article-title":"Adolescent varicocele: Efficacy of indication-to-treat protocol and proposal of a grading system for postoperative hydroceles","volume":"14","author":"Zundel","year":"2018","journal-title":"J. Pediatr. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"10.e1","DOI":"10.1016\/j.jpurol.2017.06.017","article-title":"Two decades of experience with laparoscopic varicocele repair in children: Standardizing the technique","volume":"14","author":"Esposito","year":"2018","journal-title":"J. Pediatr. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.urology.2012.02.022","article-title":"Effect of varicocelectomy on testicular volume in children and adolescents: A meta-analysis","volume":"79","author":"Li","year":"2012","journal-title":"Urology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s00383-004-1299-z","article-title":"Lymphatic sparing, laparoscopic varicocelectomy: A new surgical technique","volume":"20","author":"Tan","year":"2004","journal-title":"Pediatr. Surg. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.ijsu.2011.07.430","article-title":"Dye assisted lymphatic sparing subinguinal varicocelectomy. A prospective randomized study","volume":"9","author":"Shoma","year":"2011","journal-title":"Int. J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jpurol.2007.09.005","article-title":"Lymphatic preservation using methylene blue dye during varicocele surgery: A single-center retrospective study","volume":"4","author":"Piro","year":"2008","journal-title":"J. Pediatr. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1097\/SLA.0000000000004061","article-title":"Anaphylactic Reaction Rates to Blue Dyes Used for Sentinel Lymph Node Mapping: Systematic Review and Meta-analysis","volume":"273","author":"Perenyei","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.juro.2007.05.072","article-title":"Safety and efficacy of intratesticular injection of vital dyes for lymphatic preservation during varicocelectomy","volume":"178","author":"Makari","year":"2007","journal-title":"J. Urol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.2047-2927.2013.00142.x","article-title":"Adolescent varicocelectomy: Does artery sparing influence recurrence rate and\/or catch-up growth?","volume":"2","author":"Fast","year":"2014","journal-title":"Andrology"},{"key":"ref_41","first-page":"8","article-title":"Varicocele Surgery: Three Years Experience: Varicocele Surgery","volume":"6","author":"Azizoglu","year":"2023","journal-title":"Pak. Biomed. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/and.12458","article-title":"Varicocele treatment in paediatric age: Relationship between type of vein reflux, surgical technique used and outcomes","volume":"48","author":"Camoglio","year":"2016","journal-title":"Andrologia"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"537.e1","DOI":"10.1016\/j.jpurol.2021.05.009","article-title":"15-Year varicocelectomy outcomes in pediatric age: Beware of genitofemoral nerve injury","volume":"17","author":"Campos","year":"2021","journal-title":"J. Pediatr. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3814\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:42:57Z","timestamp":1760031777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113814"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113814","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,29]]}}}